Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy : Results from the ESCAPE-NA1 Trial.

IF 2.4 3区医学 Q2 CLINICAL NEUROLOGY

Clinical Neuroradiology Pub Date : 2022-09-01 Epub Date: 2022-01-07 DOI:10.1007/s00062-021-01123-0

Petra Cimflova, Nishita Singh, Johanna M Ospel, Martha Marko, Nima Kashani, Arnuv Mayank, Ricardo Hanel, Diogo C Haussen, Aditya Bharatha, David Volders, Manraj K S Heran, Alexandre Y Poppe, Brian van Adel, Bijoy K Menon, Manish Joshi, Andrew Demchuk, Ryan McTaggart, Raul G Nogueira, Jeremy L Rempel, Charlotte Zerna, Michael Tymianski, Michael D Hill, Mayank Goyal, Mohammed A Almekhlafi

{"title":"Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy : Results from the ESCAPE-NA1 Trial.","authors":"Petra Cimflova, Nishita Singh, Johanna M Ospel, Martha Marko, Nima Kashani, Arnuv Mayank, Ricardo Hanel, Diogo C Haussen, Aditya Bharatha, David Volders, Manraj K S Heran, Alexandre Y Poppe, Brian van Adel, Bijoy K Menon, Manish Joshi, Andrew Demchuk, Ryan McTaggart, Raul G Nogueira, Jeremy L Rempel, Charlotte Zerna, Michael Tymianski, Michael D Hill, Mayank Goyal, Mohammed A Almekhlafi","doi":"10.1007/s00062-021-01123-0","DOIUrl":null,"url":null,"abstract":"Background: Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial.Methods: Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built.Results: Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46).Conclusion: The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":"32 3","pages":"799-807"},"PeriodicalIF":2.4000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00062-021-01123-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 3

Abstract

Background: Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial.

Methods: Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b-3 per attempt. The secondary outcome was successful reperfusion eTICI 2b-3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built.

Results: Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24-3.40 and OR 1.92; 95% CI: 1.16-3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07-2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47-5.35 and OR 2.05; 95% CI: 1.09-3.84, respectively) was associated with first-pass eTICI 2b-3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b-3 reperfusion (OR 1.95; 95% CI: 1.10-3.46).

Conclusion: The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.

查看原文本刊更多论文

ESCAPE-NA1试验结果:机械取栓过程中支架回收器特性与成功再灌注的关系

背景:再灌注成功与否决定了血管内取栓术的治疗效果。在ESCAPE-NA1试验中，我们评估了支架回收器的特性及其与再灌注的关系。方法:对每次再灌注分级进行独立重新评分。评估以下特征:支架的长度和直径，支架内血栓的位置，旁路效果，在上或下MCA主干的部署，球囊引导导管和远端通路导管的使用。主要终点是成功再灌注，定义为脑梗死扩大溶栓(eTICI)每次尝试2b-3。次要结果为第一次尝试后eTICI 2b-3再灌注成功。为每个支架回收器特征建立单独的回归模型，并建立探索性多变量模型来检验所有特征对再灌注成功的影响。结果:在试验的1105例患者中，809例使用支架回收器(1241次尝试)被纳入主要分析。751例尝试使用支架回收器作为一线入路。一次成功的尝试与支架近端或中间三分之一的血栓位置相关(or 2.06;95% CI: 1.24-3.40, OR为1.92;95% CI: 1.16-3.15，分别与远端三分之一相比)和旁路效应(OR 1.7;95% ci: 1.07-2.72)。血栓位置在近端或中三分之一(or 2.80;95% CI: 1.47-5.35, OR 2.05;95% CI分别为1.09-3.84)与首过eTICI 2b-3再灌注相关。在考虑所有特征的探索性分析中，旁路效应是eTICI 2b-3再灌注的唯一独立预测因子(OR 1.95;95% ci: 1.10-3.46)。结论:旁路效应的存在和血栓定位在近端和中三分之一支架内与再灌注成功密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

5.00

自引率

3.60%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.